Signs and Symptoms of Endometrial Cancer
Abnormal uterine bleeding is the cardinal presenting symptom of endometrial cancer, occurring in approximately 90% of cases, with postmenopausal bleeding being the most common and critical warning sign. 1
Primary Presenting Symptoms
Vaginal Bleeding
- Postmenopausal bleeding is the hallmark symptom and should always prompt immediate evaluation for endometrial cancer 1, 2, 3
- In premenopausal women, irregular or abnormal uterine bleeding may be the presenting complaint 1
- Postmenopausal bleeding has an odds ratio of 32.99 compared to healthy controls, making it the strongest predictor of endometrial cancer 4
Abnormal Vaginal Discharge
- Abnormal vaginal discharge is significantly associated with endometrial cancer, with 55.4% of cases reporting this symptom 4
- The odds ratio for abnormal discharge is 8.8 compared to controls undergoing annual visits 4
- This symptom is often underrecognized but should raise concern for malignancy 4
Less Common Presentations
Pain-Related Symptoms
- Pelvic pain may occur when hematometra (blood-filled uterus) or pyometra (pus-filled uterus) develops 5
- Pain is not typically an early symptom and suggests more advanced or complicated disease 5
Asymptomatic Cases
- Some endometrial cancers are completely asymptomatic and discovered incidentally during ultrasound examination or after hysterectomy performed for other indications 5
- Asymptomatic findings may include endometrial polyps or abnormally increased endometrial thickness on imaging 5
- In postmenopausal women, these findings are typically focal areas surrounded by atrophic mucosa 5
Clinical Context and Timing
Age Distribution
- More than 90% of cases occur in women older than 50 years, with a median age of 63 years 1
- Up to 25% of cases may occur in premenopausal women 1
- Women aged 60-79 have experienced a >40% increase in incidence between 1993 and 2007 1
Early Detection Advantage
- The early symptom of irregular vaginal bleeding in this predominantly postmenopausal population prompts patients to seek care when disease is at an early, treatable stage 1
- Approximately 75% of women are diagnosed with stage I disease confined to the uterus due to early symptom recognition 1
- Five-year survival for stage I patients is 90% 1
Critical Clinical Pitfalls
Any postmenopausal bleeding must be considered endometrial cancer until proven otherwise and requires prompt evaluation with either transvaginal ultrasonography (endometrial thickness ≤4 mm has >99% negative predictive value) or endometrial biopsy 3. Office endometrial biopsies have a false-negative rate of approximately 10%, so a negative biopsy in a symptomatic patient must be followed by fractional dilation and curettage under anesthesia 1. The presence of both postmenopausal bleeding and abnormal vaginal discharge together should heighten suspicion and prompt immediate gynecological evaluation 4.